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African Journal of Reproductive Health Jun 2020Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uga nda. We explored women's perceptions of the...
Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uga nda. We explored women's perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June-August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and children. Barriers to early treatment seeking included inadequate financial and social support, erroneous perceptions about fistula causes and curability, incorrect diagnoses, and delayed or lack of care at health facilities. Our study supports broad educational and awareness activities, facilitation of social and financial support for accessing care, and improving the quality of emergency obstetric care and fistula treatment surgical capacity to reduce women's suffering.
Topics: Adult; Attitude to Health; Delivery, Obstetric; Female; Focus Groups; Health Services Accessibility; Humans; Interviews as Topic; Maternal Health Services; Obstetric Labor Complications; Patient Acceptance of Health Care; Pregnancy; Qualitative Research; Rectovaginal Fistula; Social Stigma; Uganda; Vesicovaginal Fistula; Young Adult
PubMed: 34077099
DOI: 10.29063/ajrh2020/v24i2.13 -
Tropical Medicine & International... Jun 2020To describe the frequency, causes and post-repair outcomes of NOF in hospitals supported by the Fistula Care Plus (FC+) project in the Democratic Republic of Congo.
OBJECTIVE
To describe the frequency, causes and post-repair outcomes of NOF in hospitals supported by the Fistula Care Plus (FC+) project in the Democratic Republic of Congo.
METHODS
Retrospective cohort study from 1 January 2015 to 31 December 2017 in three FC + supported fistula repair sites.
RESULTS
Of 1984 women treated for female genital fistula between 2015 and 2017 in the three FC + supported hospitals, 384 (19%) were considered to be non-obstetric fistula (NOF) cases. 49.3% were married/in a relationship at the time of treatment vs. 69% before the fistula, P < 0.001. Type III (n = 247; 64.3%) and type I (n = 121; 31.5%) fistulas according to Kees/Waaldijk classification were the most common. The main causes of NOF were medical procedure (n = 305; 79.4%); of these, caesarean section (n = 234; 76.7%) and hysterectomy (n = 54; 17.7%) were the most common. At hospital discharge, the fistula was closed and dry in 353 women (95.7%).
CONCLUSION
Non-obstetric fistula, particularly due to iatrogenic causes, was relatively common in the DRC, calling for more prevention that includes improved quality of care in maternal health services.
Topics: Adolescent; Adult; Cesarean Section; Democratic Republic of the Congo; Female; Humans; Hysterectomy; Middle Aged; Parity; Residence Characteristics; Retrospective Studies; Severity of Illness Index; Socioeconomic Factors; Vesicovaginal Fistula; Young Adult
PubMed: 32223055
DOI: 10.1111/tmi.13394 -
PloS One 2021The advent of Covid-19 pandemic adversely affected many programs worldwide, public health, including programming for obstetric fistula were not spared. Obstetric fistula...
The advent of Covid-19 pandemic adversely affected many programs worldwide, public health, including programming for obstetric fistula were not spared. Obstetric fistula is an abnormal connection between the vagina and the bladder or the rectum resulting from obstetric causes, mainly prolonged obstructed labour. Zimbabwe has two obstetric fistula repair centers. Because the program uses specialist surgeons from outside the country, the repairs are organized in quarterly camps with a target to repair 90 women per quarter. This study aimed at assessing the impact of restrictions on movement and gathering of people brought about by the Cocid-19 pandemic and to characterize participants of the camp which was held in the midst of the Covid-19 pandemic at Mashoko Hospital. Specifically it looked at how Covid-19 pandemic affected programming for obstetric fistula repair and characterized participants of the fistula camp held in November to December 2020 at one of the repair centers. A review of the dataset and surgical log sheets for the camp and national obstetric fistula dataset was conducted. Variables of interest were extracted onto an excel spreadsheet and analyzed for frequencies and proportions. Data were presented in charts, tables and narratives. The study noted that Covid-19 pandemic negatively affected performance of fistula repairs greatly with only 25 women repaired in 2020 as compared to 313 in 2019. Ninety women were called to come for repairs but 52 did not manage to attend due to reasons related to the restriction of the Covid-19 pandemic lockdown. Two thirds of those women suffered from urinary incontinence while the other third had fecal incontinence. The successful repair rate was 92%. This study concluded that the pandemic greatly affected programming of fistula repair in the country and recommended the Ministry of Health and Child Care to institute measures to resume programming as soon as the situation allows.
Topics: Adolescent; Adult; COVID-19; Cross-Sectional Studies; Female; Government Programs; Humans; National Health Programs; Obstetric Labor Complications; Pandemics; Pregnancy; Retrospective Studies; Vesicovaginal Fistula; Young Adult; Zimbabwe
PubMed: 33793657
DOI: 10.1371/journal.pone.0249398 -
Reproductive Health Jan 2022Obstetric fistula (OF) is a significant cause of maternal morbidity in lower resource settings where women experience obstructed labor without timely access to skilled...
BACKGROUND
Obstetric fistula (OF) is a significant cause of maternal morbidity in lower resource settings where women experience obstructed labor without timely access to skilled obstetric care. The true prevalence of OF is unknown; however, it is estimated to affect 2 to 3.5 million women globally. The Demographic and Health Surveys' (DHS) Fistula Module includes the OF symptom questions most frequently used for prevalence estimates, but these questions have not been validated. The aim of this study is to validate a symptom-based screening questionnaire for OF, including a question in the DHS' Fistula Module.
METHODS
With an international panel of fistula surgeons, we developed and face-validated a screening questionnaire that assessed for symptoms of lower urinary tract fistula (LUTF) and lower gastrointestinal tract fistula (LGTF), as well as urinary and fecal incontinence (UI, FI). We evaluated the discriminative ability of the questionnaire using a case-control study design in a 1:2:2 ratio: cases were parous women with fistula confirmed on examination, controls included parous women without fistula on examination, with and without UI symptoms. All women underwent screening for fistula symptoms and a physical examination, with examiners blinded to screening results.
RESULTS
Of the 367 Rwandan women who completed the questionnaires and underwent clinical examination, 59 women had LUTFs and 34 had LGTFs, 274 women were classified as controls with and without symptoms of UI. All LUTF screening questions performed well, including the DHS fistula question. The combination of two LUTF screening questions had the highest sensitivity (100%; 95% CI 94%, 100%), specificity (96%; 95% CI 93%, 98%), and area under the curve (AUC) (0.98). The combination of a LGTF screening question and FI question demonstrated the highest sensitivity (97%; 95% CI 85%, 100%), specificity (98%; 95% CI 95%, 99%) and AUC (0.98).
CONCLUSIONS
Our OF screening questionnaire, including the DHS fistula question, demonstrated high sensitivities, specificities, and AUC.
Topics: Case-Control Studies; Female; Humans; Obstetric Labor Complications; Physical Examination; Pregnancy; Surveys and Questionnaires; Vesicovaginal Fistula
PubMed: 35042512
DOI: 10.1186/s12978-021-01317-2 -
International Journal of Gynaecology... Jan 2020To analyze trends in iatrogenic urogenital fistula among patients admitted for fistula repair at the Pakistan Institute of Medical Sciences, Islamabad.
OBJECTIVE
To analyze trends in iatrogenic urogenital fistula among patients admitted for fistula repair at the Pakistan Institute of Medical Sciences, Islamabad.
METHODS
In this longitudinal study, all patients who presented for fistula repair between 2006 and 2018 were included in the study. Patient data were collected on age, parity, and type and etiology of fistula, which was classified as ischemic or iatrogenic.
RESULTS
Of 634 fistula patients, 371 (58.5%) had iatrogenic fistula, while 263 (41.5%) patients developed ischemic fistula due to obstructed labor. Mean age of patients was 31.6 years. Yearly trends showed an increase in iatrogenic fistula from 43.2% in 2006-2008 to 71.4% in 2017-2018. The major etiological contributor to iatrogenic fistula was hysterectomy (52.5%), followed by cesarean hysterectomy (26.4%), and cesarean delivery (19.9%).
CONCLUSION
A rising trend in iatrogenic fistula was observed. This emphasizes the need for optimization of surgical approaches and surgical skills. Moreover, gynecologic surgeries should be restricted to authorized gynecologic surgeons.
Topics: Adult; Cesarean Section; Female; Gynecology; Humans; Hysterectomy; Iatrogenic Disease; Longitudinal Studies; Pakistan; Pregnancy; Vesicovaginal Fistula
PubMed: 31943186
DOI: 10.1002/ijgo.13037 -
In Vivo (Athens, Greece) 2022Vesico-uterine fistulas represent a rare type of genito-urinary fistulas; however, due to the increasing incidence of Caesarean section (C-section) in the last decade,... (Review)
Review
BACKGROUND/AIM
Vesico-uterine fistulas represent a rare type of genito-urinary fistulas; however, due to the increasing incidence of Caesarean section (C-section) in the last decade, this abnormal communication between the urinary and genital tracts has been reported more often after such surgical procedures. The aim of the current article was to report the case of a 28-year-old patient who was submitted to surgery for a vesico-uterine fistula seven years after a C-section.
CASE REPORT
The 28-year-old patient with a previous history of four vaginal deliveries and one C-section was self-presented to the Gynecology Department for cyclic hematuria and diagnosed with a vesico-uterine fistula after injecting methylene blue in the uterine cavity during hysteroscopy. The patient was further submitted to surgery, and a parcelar myometrectomy en bloc with parcelar cystectomy, cystography, and prophylactic salpingectomy was performed. The postoperative outcome was uneventful.
CONCLUSION
Although vesico-uterine fistulas represent rare events, they should be considered, especially in young patients with a previous history of C-section.
Topics: Adult; Cesarean Section; Female; Fistula; Humans; Pregnancy; Urinary Bladder; Urinary Bladder Fistula; Uterine Diseases
PubMed: 34972758
DOI: 10.21873/invivo.12734 -
Cureus Sep 2023Pubosymphyseal urinary fistula (PUF) is a rare condition that involves an abnormal connection between the urinary bladder and the pubic bone. It can occur after trauma,...
Pubosymphyseal urinary fistula (PUF) is a rare condition that involves an abnormal connection between the urinary bladder and the pubic bone. It can occur after trauma, radiation therapy, or surgery to the pelvis. It is also reported with chronic indwelling Foley catheter use. In this case report, we present a 56-year-old male who developed a fistula complicated by osteomyelitis pubis following external beam radiation for a urinary bladder sarcomatoid tumor. Patients at high risk of PUF may present with urinary leakage, pelvic pain, and infection, making diagnosis challenging. The condition can lead to chronic pelvic pain and long-term opioid use if left untreated. Diagnosis is typically made through imaging studies (CT scan or MRI) and confirmed with cystoscopy. Treatment usually involves urinary diversion/surgical repair of the fistula and management of any associated infection or complications. The prognosis is generally good if the condition is diagnosed and treated promptly. While it is rare, it can have significant consequences that require prompt diagnosis and treatment.
PubMed: 37908937
DOI: 10.7759/cureus.46261 -
International Journal of Gynaecology... Jan 2020Female genital fistula is associated with significant physical, psychological, and economic consequences; however, a knowledge and practice gap exists around services...
BACKGROUND
Female genital fistula is associated with significant physical, psychological, and economic consequences; however, a knowledge and practice gap exists around services adjunct to fistula surgery.
OBJECTIVES
To examine rehabilitation and reintegration services provided adjunct to genital fistula surgery, map existing programming and outcomes, and identify areas for additional research.
SEARCH STRATEGY
We searched the published and grey literature from January 2000 to June 2019. Two reviewers screened articles and extracted data using standardized methods.
SELECTION CRITERIA
Research and programmatic articles describing service provision in addition to female genital fistula surgery were included.
DATA COLLECTION AND ANALYSIS
Of 3047 published articles and 2623 unpublished documents identified, 26 and 55, respectively, were analyzed.
MAIN RESULTS
Programming identified included combinations of health education, physical therapy, social support, psychosocial counseling, and economic empowerment, largely in sub-Saharan Africa. Improvements were noted in physical and psychosocial health.
CONCLUSIONS
Existing literature supports holistic fistula care through adjunct reintegration programming. Improving the evidence base requires implementing robust study designs, increasing reporting detail, and standardizing outcomes across studies. Increased financing for holistic fistula care is critical for developing and supporting programming to ensure positive outcomes.
Topics: Africa South of the Sahara; Female; Holistic Health; Humans; Physical Therapy Modalities; Social Support; Treatment Outcome; Vesicovaginal Fistula
PubMed: 31943181
DOI: 10.1002/ijgo.13039 -
BMC Urology Feb 2020We report a rare case of spontaneous vesicorectal fistula.
BACKGROUND
We report a rare case of spontaneous vesicorectal fistula.
CASE PRESENTATION
A 13-year-old female spina bifida patient who complained of fecal and urinary incontinence was eventually diagnosed with a spontaneous vesicorectal fistula. We hypothesized that infection, neurogenic bowel and neurogenic bladder caused her vesicorectal fistula. The patient refused the operation, and she is currently in a delicate balance.
CONCLUSIONS
Early repair of the fistula is necessary. The treatment of neurogenic bladder after fistula repair is difficult and deserves further observation and follow-up.
Topics: Adolescent; Fecal Incontinence; Female; Humans; Rectal Fistula; Urinary Bladder Fistula; Urinary Bladder, Neurogenic; Urinary Incontinence
PubMed: 32093659
DOI: 10.1186/s12894-020-00585-7 -
International Braz J Urol : Official... 2014Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few...
INTRODUCTION
Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported.
OBJECTIVES
Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure); Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter.
RESULTS
Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7). Mean operative time was 2,5 (1,8-3,2) hours. Mean blood loss was 150 (100-200)mL. Complication rate was 10% (one case of urinary infection treated conservatively). Mean hospital stay was 1,2 (1-2) days. Mean return to normal and activities was 20 (15-30) days. For nine patients mean sexual intercourse time was 3 (1-6) months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy). Mean follow-up was 36 (12-60) months.
CONCLUSIONS
Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.
Topics: Female; Humans; Laparoscopy; Middle Aged; Reproducibility of Results; Treatment Outcome; Vesicovaginal Fistula
PubMed: 25010315
DOI: 10.1590/S1677-5538.IBJU.2014.03.23